Mandating Influenza Vaccination of Health Care Workers: A Patient Safety, Quality of Care, and Public Trust Issue

Introduction

Among the highest moral and ethical obligations of the healing professions are to “do no harm” and to set aside personal preferences in deference to protecting patient safety in the context of delivering health care. Patient safety must be seen as a sacrosanct duty and moral obligation of health professionals. A model issue in this regard is that of influenza immunization of health care workers (HCWs). Despite decades of influenza vaccine safety and efficacy data, pleas and innumerable programs to immunize HCWs, empiric use and evaluation of informed declination, calls for influenza vaccine requirements for HCWs, and ample evidence of harm due to nosocomial influenza, the majority of HCWs across the globe still fail to be immunized. The failure to be immunized, we believe, represents a failure of ethical medical and nursing practice, a failure of leadership among hospitals and health care institutions, and a breach of the public trust accorded to the healing professions.

Abstract

Influenza causes yearly epidemic disease and occasional pandemics. Because of this, health care workers (HCWs) are routinely exposed to influenza in the course of their patient care duties. As a result, transmission from HCW to HCW, and HCW to patients occurs, leading to evidence for increased morbidity and mortality among the patients cared for by unimmunized HCWs. Despite the existence of safe and effective influenza vaccines, the majority of HCWs still fail to receive seasonal influenza vaccines. Thus, influenza immunization of HCWs must be seen as a patient safety and quality of care issue. The failure to be immunized, we believe, represents a failure of ethical medical and nursing practice, a failure of leadership among hospitals and health care institutions, and a breach of the public trust accorded to the healing professions. Herein we discuss the rationale and evidence for requiring influenza immunization of HCWs; describe the current state of such programs in the United States and Europe; discuss the implementation of mandatory programs and their results at the practice, institutional, legislative, and professional society levels; and conclude with a call for mandating influenza immunization of all HCWs.

Keywords

influenza vaccines, health care workers, influenza, hospital, health personnel